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Case Reports
. 2021 Apr 15;60(8):1211-1215.
doi: 10.2169/internalmedicine.5889-20. Epub 2020 Nov 23.

Intraductal Papillary Mucinous Neoplasm with Pancreatogastric Fistula

Hideaki Takahashi  1   2 , Yasushi Adachi  3 , Kazunari Nakahara  2 , Takefumi Kikuchi  3 , Hiroaki Mita  3 , Masahiro Nakamura  3 , Yukinari Yoshida  3 , Yasuo Kato  3 , Yoshifumi Ishii  4 , Takao Endo  3
Affiliations
Case Reports

Intraductal Papillary Mucinous Neoplasm with Pancreatogastric Fistula

Hideaki Takahashi et al. Intern Med. .

Abstract

We herein report a rare case of intraductal papillary mucinous neoplasm with a pancreatogastric fistula in an elderly Japanese man admitted to our hospital. The pancreatogastric fistula was confirmed using endoscopic retrograde pancreatography via a cannulated guidewire placed in the stomach. Six months after admission, the patient was diagnosed with intraductal papillary mucinous carcinoma. A pancreatogastric fistula is generally a rare complication of intraductal papillary mucinous neoplasm. It was caused by mechanical penetration in this case. Interestingly, we also observed endoscopic and histochemical mucosal changes in the fistula.

Keywords: endoscopic retrograde cholangiopancreatography; intraductal papillary mucinous carcinoma; intraductal papillary mucinous neoplasm; mechanical penetration; pancreatogastric fistula.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Findings of diagnostic imaging. A: Esophagogastroduodenoscopy showing the papillary tumor with a typical fish egg-like mucosal lesion on the fistula. B: Abdominal enhanced computed tomography showing a cystic lesion of the pancreas and pancreatogastric fistula. C: Endoscopic ultrasonography confirming a pancreatogastric fistula.
Figure 2.
Figure 2.
A pathological examination of the initial biopsy specimen. A: Hematoxylin and Eosin staining: low-power microscopy showing a non-invasive intraductal papillary mucinous neoplasm border with the fistula in the stomach. B, C: Immunohistochemical staining revealing that around 30% neoplastic cells were Ki-67-positive (B), and the majority were p53-negative (C).
Figure 3.
Figure 3.
Findings of endoscopic retrograde cholangiopancreatography. A: Endoscopic retrograde cholangiopancreatography showing the main pancreatic duct and pancreatogastric fistula. A guidewire was inserted into the stomach via the pancreatogastric fistula. B: Endoscopically confirmed guidewire placement in the stomach.
Figure 4.
Figure 4.
Follow-up imaging findings. A: Abdominal computed tomography showing gradual enlargement of the pancreatogastric fistula and pancreatic cystic lesion during follow-up. In addition, there were several metastatic lesions in the liver along with dilatation of the intrahepatic bile duct. B: Compared with the previous esophagogastroduodenoscopy findings, the mucous membrane was irregular, and the fish egg-like appearance of the fistula had disappeared.
Figure 5.
Figure 5.
A pathological examination of the second biopsy specimen. A: Hematoxylin and Eosin staining: high-power microscopy showing an invasive intraductal papillary mucinous carcinoma with a fistula in the stomach. B: Immunohistochemically, around 70% of the neoplastic cells showed Ki-67 expression. C: Immunohistochemically, around 40% of the neoplastic cells showed p53 expression.
See this image and copyright information in PMC

References

    1. Ohashi K, Murakami Y, Maruyama M, et al. . Four cases of mucus-secreting pancreatic cancer (in Japanese). Prog Digest Endosc 20: 348-351, 1982.
    1. Tanaka M, Chari S, Adsay V, et al.; International Association of Pancreatology. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6: 17-32, 2006. - PubMed
    1. Tanaka M, Fernández-del Castillo C, Adsay V, et al.; International Association of Pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12: 183-197, 2012. - PubMed
    1. Tanaka M, Fernandez-del Castillo C, Kamisawa T, et al.; International Association of Pancreatology. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 6: 738-753, 2017. - PubMed
    1. Basturk O, Hong SM, Wood LD, et al.; Baltimore Consensus Meeting. A revised classification system and recommendations from the Baltimore Consensus Meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol 39: 1730-1741, 2015. - PMC - PubMed

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